Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 60613-60617 1113

(total of 27 states). This project promotes: a) health promotion and prevention
in schools; b) training of professionals for project development; c) promotion
of NGOs initiatives; d) needle exchange programs; and) back up of treatment
for IDU. The project has a budget of 10 million dollars (80% from the Brazilian
Government, 20% from UNDCP), added by local counterpart of approximately
30%, for a period of 4 years.
Results: a political integration and an operational network of institutions dealing
with the different target-population in the States involved were created by the
Project: 1029 schools and 32 000 students involved; 5 institutions for training
and monitoring project personnel in governmental and non governmental organizations; 20 NGOs carrying out research, prevention and treatment projects; 8
institutions of backup for treatment; 14 needle exchange programs. Activities are
being developed in 14 states. All 56 subprojects are monitored by the Project
coordination.
Lessons Learned: For the development of actions in the field of drugs and
AIDS, it is necessary to establish political and operational coordination among
the executors and their environment. In addition, social marketing and advocacy
strategies are important for strengthening the sustainability of the activities.
[60613 HIVAIDS horizontal technical cooperation in Latin
America and the Caribbean
Pedro Chequer1, Julio Barrios2, L. Astarlo A.3, R. Child4, C. Nunez5, L. Toro4,
P. Uribe6, M. Santin7. Ministerio Da Saude Bloco G Sobreloja Esplanada Dos
Ministerios Brasilia,; 2Program Nacional De AIDS/M. DA Saude, Brasilia DF,
Brazil; 3Programa Nacional SIDA/M. De La Salud, Buenos Aires CF, Argentina;
4Comision Nacional SIDA/M. De La Salud, Santiago, Chile; 5Division
ETS/SIDA/M. Salud, Tegucigalpa, Honduras; 6Comision Nacional SIDA/M.
Salud, Mexico, Mexico,; 7Program Nacional ETS/SIDA, Habana, Cuba
Issue: The creation of the HIV/AIDS Horizontal Technical Cooperation Group
(HTCG) expresses the process of implementation of a permanent system of
cooperation and technical support among the national programs of the Latin
American and the Caribbean countries.
Project:: The HTCG main task is to widen regional capacities to build more
efficient responses to HIV/AIDS considering characteristics and potentialities of
each country. The HTCG principal strategy is the continuous development of
technical cooperation actions, understood as a process of sharing experiences,
knowledges, technologies in equality of circumstances, beeing learning a reciprocal transference of the programs involved, not vertically, based on a commonly
negotiated agenda. HTCG is organized as a network and has created a collective instance for decision making and the development of technical cooperation,
integrated by the whole country members that is called HTCG Annual Meeting as
well as a Technical Secretary (pro-tempore) and six Focal Points.
Results: The National Programs of Argentina, Brazil, Colombia, Costa Rica,
Cuba, Chile, Ecuador, Honduras, Mexico, Nicaragua, Panama, Dominican Republic, Uruguay and Venezuela are now participant members of HTCG, developing
the following activities: publishing Horizontec, a quartelly bulletin, developing
electronic communication and networking, and implementing cooperation actions
among the country members as well as within international organizations like
UNAIDS. HTCG is organizing for September 1998, the First Latin American and
Caribbean Conference for Horizontal Technical Cooperation in HIV/AIDS, to be
held at Mexico.
Lessons Learned: The HTCG Group represents an opportunity and a strength
point for the future of National Programs of the Latin American and the Caribbean
countries who are responsible for organizing and orienting national responses to
HIV/AIDS, potentialyzing bilateral and multilateral cooperation showing that "No
one is so powerful for not to require something from the others, and nobody is so
poor for having nothing to contribute with".
60614 Evaluation of users adherence in ambulatorial services of
HIV/AIDS, in Brazil
Roberto Brant1, S.D. Deslandes2, E. Ramos3. 1SQN 315 BLOCO J Apt 301
ASA Norte 70774-100; 2Instituto Fernandes Filgueiras/FIOCRUZ, Rio De
Janeiro; 3Claves/FIOCRUZ, Rio De Janeiro, Brazil
Issue: Considering the introduction of new therapies and medicaments, specially the anti-retrovirals and those for the opportunistic infections, nowadays the
ambulatorial services are very important within the whole network, because the
enormous increasing of patients. This turn strategical the development of na
assessment process in order to observe and analyze the most important factors
that affect user's adherence to these services.
Project: In order to study the diverse aspects of the relationship between patients and services, as well to apprehend the positives and negatives conditioning
factors of this adherence, we have adopted both quantitative and qualitative
methods, technics and instruments. This means to underline anthropological and
cultural subjects, beyond the epidemiological ones. The users feelings, attitudes,
glance and speech are the most important subjects, in this proposal, linked to
the analysis of structure and processes. The sample consists of 31 ambulatorial

services spread over states and municipalities. The sample represents about
40% of the accumulated cases of AIDS of the country.
Results: The evaluation is still going on, although it can be concluded that
the combination of qualitative and quantitative methods has been very efficient
to demonstrate the important hole of perceptions, feelings and the attitudes of
health professionals and patients in adhering these services offered as much as
the availability of medicaments.

Lessons Learned: Combination of quantitative and qualitative methods
("Methodological Triangulation") is specially useful and successful as an evaluation method, turning possible a deep analysis of both objective and subjective
matters interfering the patient's adherence towards ambulatorial services of
HIV/AIDS in Brazil.
160615 STD care as a strategy for the reduction of the HIV
transmission in Brazil
Fabio Moherdaui, V.G.V. Santos, A.L.R. Vasconcelos, P.J.N. Chequer. 'Brazilian
AIDS Proram-MOH, Brasilia DF Brazil
Issues: Brasil presents high proportion of the population concentrated on the
great urban areas. The demographic characteristics, the socioeconomic inequalities and the ignorance about the patterns of behavior, faiths and sexual attitudes
suggest the need of great effort for the control of STD, which increases the risks of
HIV transmission. The long waiting for consultations, the delay of the laboratorial
results and the low quality of the health care contribute for the patients stand
back of the public services, seeking for assistance in the private sector or, more
frequently, self medicating.
Project: 1) To implement health services with personnel for the STD care using
the syndromic approach, with availability of fast laboratory tests and of adequate
and free medication. 2) To detect cases motivating the use of laboratory tests
in patients with or without symptoms and even in patients that seek the health
services with other purpose. 3) To establish the management of sex partners.
4) To stimulate the execution of activities of epidemiologic surveillance. 5) To
address the interventions for the people with high risk behavior for acquisition
of STD/HIV, guiding the education on STD in the sense of producing positive
changes of attitudes and behaviors. 6) To stimulate and to facilitate the reference
of STD cases from the commercial pharmacies to the primary health care units.
Results: Since 1994 the 25 National Training Centers accomplished the training
of approximately 2,100 health professionals from 691 health units. The objective
was to qualify that professionals so that they can do the appropriate care of STD
cases, understanding appropriate care for the immediate syndromic diagnosis
and treatment, accompanied by counseling, education and case report.
Lessons Learned: The access to health services with better resolvability and
the wide availability of drugs allows the opportune treatment of STD cases; that
takes to the reduction in the diseases evolution, its complications and in the
consequent reduction of the risk of HIV transmission and acquisition
160616 Therapeutical domicile assistance (TDA) - An alternative
of hospitalization to AIDS patients in Brazil
Claudia Cunha1, V.G.V. Santos2, P.J.N. Chequer2. 1Brazilian AIDS Program
MOH Espl. Ministerios BL. G Brasilia-DF Brazil-70058-900, 2Brazilian AIDS
Program-MOH Brasilia DF, Brazil
Objectives: To describe epidemiological and clinical profile of patients cared by
team work of Projects of Therapeutical Domicile Assistance -TDA funded by the
Brazilian Ministry of Health -MOH
Methods: A prospective epidemiological study based on standardized questionnaire applied to all patients that were enrolled in 08 services of TDA, sponsored
in 1995, in 04 states (Pernambuco, Sao Paulo, Rio de Janeiro and Rio Grande
do Sul). The questionnaire consists of a record such as sex, age, HIV risk factors,
clinic profile-current and previous pathologies, reasons for being admitted and
leaving the service, was fulfilled by the same investigator in each service.
Results: In 1997, from March to July, 118 patients were inserted in the study.
The study cohort indicated 60% male and mean age was 29 years. Median length
of stay per admission was 59 days (range 3 to 120 days). HIV risk factors were
45% heterosexual contact, 30% injection use drug, 24% homosexual contact
and 1% perinatal HIV transmission. At the moment of inclusion 26% had oral
candidiasis, 24% TB, 12% Toxo, 10% CMV, 10% KS, 10% Herpes Simples,
and 6% Herpes Zoster, 6% PCP and other pathologies were found in 40% of
patients. Reasons for being admitted were: (a) requirement of general support
care-81%, (b) necessity of endovenous therapies-33%, (c) oxigeniotherapy-2.5%
and others- 8%. 19% had (a) + (b), 3% had (a) + (c), 2% had (b) + (c) and 2%
had (a) + (b) + (c).
Conclusion: There is not a specific epidemiological pattern of patients enrolled
by these ATD projects. However, this first evaluation allowed us to suppose that
this patients should be hospitalized as in-patients and for a long stay. Both the
support of the MOH and the highly capable multidisciplinary staff have assured
the success of these non traditional possibility of hospitalization for AIDS patients
in Brazil.
|60617 Economic profile of patients beneficiary of therapeutical
domicile assistance (TDA) of the Brazilian Ministry of
Health
Claudia Cunha1, A.I.R. Vasconcelos2, V.G.V. Santos2, P.J.N. Chequer2.
1Brazilian AIDS Program MOH Espl. Ministerios BL. G Brasilia-DF

Brazil-70058-900; 2Brazilian AIDS Program-MOH Brasilia DF, Brazil
Objectives: To establish the patients' economic profile with AIDS, beneficiary by
the care offered by the projects of Therapeutical Domicile Assistance-TDA of the
Brazilian Ministry of Health.
Methods: A standard questionnaire including data on the number of minimum
wage attributed to the patient, starting from the bedding proposal for Brazilian